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FOR OFFICE USE: <br /> ----------------- ------------------- -------- -------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. _._/ _-_•___. <br /> (Complete in-Duplicate) Date Issued --- -V,6o-- <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health.District for a permit to construct and install the work herein described.. <br /> This application is made i compliance with County OMi'nancelNo. 549..A� <br /> JOB ADDRESS AND TIO -------------- - a�-=_ :---"--- <br /> Y1/l�.__•�5 f=_�C- �t�/.---e--- <br /> Owner's Name. i� i- {{ ==== _1�1_C -------------- ------------------------ = Phone <br /> 1 t <br /> Address------------R TF_ J-- - ------S- 6-------- E-- --------------- --------------------------------------- _ ----"-------- <br /> 1 ,I "` <br /> Contractor's Name---------------Pl_�CI atp--------"•------------- 1-1----------------------------- • --------,•-----------------------•-------- Phone-------- ---------------- <br /> 4 1 <br /> Apartment p House ElCommercial E] Trailer Court ❑ Moe ❑ Other tl Oth -OFFlc� <br /> Installation will serve: Resident A <br /> of living units. --� p�ooms _ Number of baths __�___ Lot size ____.14 -�e� ------------------------ <br /> Number <br /> Number of bed <br /> t ®ft. <br /> ,.:Wafer Supply: Public system ❑ Community system ❑ Private �epth to Water Table <br />,i Character of so I to a�depthof=3 feet: Sand *Grp el El Sandy Loam ❑ Clay Loam L] Clay El Adobe❑ Hardpan ❑ <br /> ._.:_ <br /> RRI <br /> Previous Applii:6 nTade: (If yes,date----------- - h No New Construction: Yes P--'_Nor❑ FHA/VA: Yes ❑ No <br /> II <br /> -TYPE­OF_'INSTALLATIONS`AND SPECIFICATIONS <br /> r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> f Septic n _t Distance from nearest weh--__,SC�..__Distance from foundation "_"--"_.Materal :111GT��__"---- r <br /> No. of compartments___ �r— Size �(SLi uidtde th._._- �z,,� <br /> Q + <br /> q //P}}. P Y 4 <br /> ;-.i_"isposal Fi Distance from nearest we31_- a____.Distance from,foundation__.._�.S%.-----Distance to nearest lot <br /> Number'of lines------------- Length of each line _.__ __ Width of trench------_5 _ ____ <br /> �" "7t' -------- <br /> W _ <br /> Type of filter material-" �Q.C1__Depth of filter materia__ ___ -_.Total length------------------ S_--"_----_-.- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation---...,___Distance to nearest lot line................. <br /> ❑ r Number of pits---------------------Lining rnaterial-----------------------Size: Diameter ---------------------Dept k_----------------------------- <br /> Cesspool: Distance from nearest well----------------- from foundation...-____ ..._ Lining material"_"___-___________________________ 1 <br /> •: t+�t' 'Size: Diameter------------------------------ -------Depth-------------- ----------------=-----------N Liquid Capacity---------------------------gals. <br /> Privy: s Distance from nearest well____;.;-"--"---_--._____"! ""`Dig*�riifd'from�nearest building-"_"_"""_"--------------""_"-----.-..__--- <br /> Distance to nearest lot line---------------------- ----------------------------------------- ---------------- -- - <br /> =------Re'mod <br /> sling,and/or. repairing (describe] ------ ( -- -------- -••-•--------------------- f ----- <br /> ----- -- ---- -------- -------------- <br /> 9 i <br /> yi --------------------- I------------- __ _____"-. <br /> N <br /> ---------LF_ """"---- -------------------"___-""._---_-__-_.-..___,_ <br /> I hereby certif g at I have prepare is application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State w,rand rules and ations f the San Joaquin Local Health District.: <br /> (Owner Contractor) <br /> (Signed) ------------ --- - --------- ----; - --- -- - -------------- - �. a"BY''-------- <br /> BY'-------- - ----- - --------------- ------------------------------------------------------- ---7(7j, <br /> -':(Plot plan, sh Ing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> ' FOR DEPARTMENT USE ONLY <br /> A-PPLICATION 'ACCEPTED BY-----77--_� a--------- --------------------------------------------------- DATE-------- <br /> ----------------------------------- ----DATE--------�= �-� ----------------- <br /> REVIEWEDBY------------------------------------------- ----------------------=----------------------- ' -------: --------- DATE-- --------------------------------------------------------- <br /> PERMITISSUED---------- ----------------------------------------------------------- --- DATE - -------- <br /> BUILDING Alterations and/or recommendations----------------------------------------------- ----------------------------------------------------------------------- <br /> ----------------------------------- <br /> i <br /> i - -------------------------------------------•-------------- <br /> -"^ -'� <br /> -- - -------------------------._.-_. - ----__._...---_..____------- <br /> // --..__-- <br /> VI Date----- . <br /> FINAL INSPEC BY: t •--.�_`lI_.... <br /> - -------f-------------- -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT " <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124-Sycamorg Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.CO. - - <br />